Medical Abortion Care

Topic Overview

A medical abortion is the use of medicines to end a pregnancy. Medical care for a medical abortion is different from medical care for a surgical abortion. This is because a medical abortion is like a miscarriage (in this case, caused by medicines) that takes place at home over 1 to 2 days and does not require your doctor to be present. After a couple of weeks of bleeding, you then see your doctor for a follow-up examination.

Care before a medical abortion

Before a medical abortion, your doctor may:

Evaluate your medical history, including any medicines you are taking.

Do a physical exam, including a pelvic examination, to evaluate your health, how long you have been pregnant, and location of the embryo or fetus.

Perform an ultrasound to confirm how far along and where the pregnancy is. Not all doctors choose to do this step.

Discuss your decision to have an abortion and your feelings about the decision.

Discuss your plans for future pregnancies and birth control use.

Explain how the medicines will work, possible side effects (nausea, vomiting, and diarrhea are common), and when to call your doctor. It is important for your doctor to know whether you:

Have access to a telephone, to call if you have problems.

Have transportation to a health care facility if you need to be evaluated.

Will be able to return for a follow-up appointment.

Are prepared for the cramping pain and bleeding that will occur as the uterine contents are passed.

Understand that a surgical abortion will be needed if a medical abortion fails to complete the process.

In addition to the medicines used to cause an abortion, your doctor will give you medicines to minimize side effects, with specific instructions for their use. These medicines are used:

Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:

No bleeding. If bleeding does not occur, then the medicines may not be working. A second dose of misoprostol may be needed. Methotrexate and misoprostol may take up to 3 weeks to be effective.

Bleeding (not spotting) for longer than 2 weeks

New, unexplained symptoms that may be caused by medicines used in your treatment

No menstrual period within 6 weeks after the procedure

Signs and symptoms of depression. Hormonal changes after a pregnancy can cause depression that requires treatment.

Complications that can occur include:

Tissue remaining in the uterus (retained products of conception). Cramping belly pain and bleeding will occur again within a week of the procedure.

Infection. Symptoms of fever of 100.4°F (38°C) or higher, pain, and belly tenderness will usually start within 2 to 3 days of the procedure. But you can have a serious infection without fever.

Blood clots blocking the cervix (hematometra). If the uterus doesn't contract to pass all of the tissue, the cervical opening can become blocked. This prevents blood from leaving the uterus. The uterus will become enlarged and tender. Belly pain, cramping, and nausea may be present.

Moderate to severe bleeding (hemorrhage). Bleeding may be more than normal if:

Products of conception are retained in the uterus.

The uterus has not contracted toward its prepregnancy size (atony).

Uterine muscle rupture has occurred. In rare cases, a uterine incision scar tears open when a medicine is used to induce contractions.

When a medical abortion fails, a surgical abortion must be done as follow-up to prevent complications or development of a fetus with abnormalities.

Follow-up examination after a medical abortion

A follow-up examination is done about 2 weeks after a medical abortion. The examination may include:

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